Psychogeriatric consultation. General Hospital versus home for the aged.

As more elderly persons are institutionalized in long-term care settings, there will be an increasing need for psychiatric consultation-liaison (C/L) services. An understanding of how patterns of C/L service provision differ in these settings from those in the general hospital is important for efficient use of resources. In this study, certain characteristics of psychiatric consultations for the elderly patients in a general hospital were compared to consultations in a home for the aged. Three groups of 30 patients were examined: patients age 60 and over in a general hospital (GH), patients under age 60 in a general hospital (GHY), and patients in a home for the aged (HA). GH and GHY shared many characteristics, but there were significant differences between HA and GH: Consultations for HA were less likely to be urgent and more likely to be for management. Dementia was diagnosed in 70% of HA versus 27% in GH. Types of interventions were similar in GH and HA except that more psychotherapy was done in HA. In HA more contact was made with allied health professionals, while in GH there was more contact with medical personnel. GH patients were seen more intensively during the first 2 weeks following referral. We conclude that the major part-time attendance of a psychiatrist skilled in both the behavioral management of demented patients and liaison with allied health professionals is likely to be sufficient in long-term care institutions for elderly patients. However, the psychiatrist must also be proficient in the education of the staff of the institution so as to encourage the referral of all those patients who require psychiatric attention.

Assessing the protective service needs of the impaired elderly living in the community.

The aim of this paper is to define the guidelines for the preparation of reports on protective service needs of the (impaired) elderly living in the community. Such guidelines are of special importance both because they have not been set down in detail, and because of recent moves to establish adult guardianship legislation in various jurisdictions. Three major areas are addressed in detail: the definition of an adequate assessment; the essential components of each report; and who should have responsibility for the assessment process. Medico-legal issues of guardianship are reviewed.